- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16.22 / $100.00 / $5,370.32
| Facility | | $16.22 | $100.00 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $19.95 / $363.08
| Professional | | $12.88 | $19.95 | $363.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $26.92 / $61.66 / $102.33
| Facility | | $26.92 | $61.66 | $102.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $21.38 / $21.38 / $29.51
| Professional | | $21.38 | $21.38 | $29.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.59 / $13.80 / $56.23
| Facility | | $12.59 | $13.80 | $56.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $10.96 / $17.78 / $47.86
| Professional | | $10.96 | $17.78 | $47.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $30.20 / $151.36
| Professional | | $30.20 | $30.20 | $151.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.14 / $21.38 / $21.38
| Professional | | $15.14 | $21.38 | $21.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.88 / $17.78 / $42.66
| Professional | | $12.88 | $17.78 | $42.66 |